Behavioural treatments to stop smoking before surgery reduce complications after surgery

Thomsen T, Villebro N, Moller AM Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.

Review question

Does helping people to quit smoking before they have elective surgery result in fewer complications after surgery?

Background

People who smoke are more likely to have complications after surgery. Several treatments help people to stop smoking, including written materials, brief advice, counselling, and medications. Providing support to stop smoking before elective surgery may reduce complications after surgery.

How the review was done

The researchers did a systematic review, searching for studies published up to January 2014. They found 13 randomized controlled trials with 1210 people. The trials included:

• people of any age who were having elective surgery, and
• support to stop smoking in the form of brief or intensive behavioural treatments or medications that started at least 48 hours before surgery.

What the researchers found

There were too few studies on medications to combine the results.

Behavioural treatments were brief or intensive (that is, included weekly counselling sessions for 4 to 8 weeks).

Compared with the control group:

• about 27 fewer people out of 100 had complications 4 weeks after surgery in the intensive treatment group, but there was no difference in complications with brief treatment;
• about 46 more people out of 100 in the intensive treatment group and about 12 more out of 100 in the brief treatment group had stopped smoking at the time of surgery; and
• about 21 more people out of 100 in the intensive treatment group had stopped smoking after 12 months, but there was no difference in stopping smoking with brief treatment.

Conclusion

Helping people to stop smoking with intensive behavioural treatment that starts before surgery reduces complications after surgery and increases the number of people who stop smoking at the time of surgery and after 1 year.

Intensive or brief behavioural treatment vs control to stop smoking before elective surgery

*Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.